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�CTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 12�$ ��h ��' ��I
<br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF
<br /> BUILDING TYPE: I�SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING:
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<br /> CONTRACT PRICE OF WORK: $
<br /> NUMBER OF DEVICES if low voltage):
<br /> FIRE ALARM? ❑YES ❑NO
<br /> ASSOCIATED BUILDING PERMIT# if a licable):
<br /> DESCRIPTION OF WORK: p S`��" � ���-Z uVv�Q.�,�
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<br /> OWNER NAME: 1(1(�Q�� (�s�l�,l(V�� TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReeT (� ��h S�
<br /> CITY C/�V"��� STATE v�. ZIP �0���
<br /> OWNER PHONE: �LS-��+v�(Sl�O�p� OWNER EMAIL:
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<br /> CONTRACTOR NAME: � p lfYl S
<br /> CONTRACTOR ADDRESS: srReer PC� � t p
<br /> CITY �/l S`� f � STATE !� ZIP tQ���
<br /> CONTRACTOR PHONE: �,P � CQ�FS• � CONTRACTOR EMAIL: � � s�-+�— (S�/1 • C
<br /> CONTRACTOR LIC.#(REQUIRED): ����'�C ��F� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): b�g
<br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ��.���, ��O
<br /> ��� CONTACT EMAIL: �� � �� � , �'��
<br /> AGREEMENT:I hereby certify thaf 1 have read and examined fhis application and know the same to be true and correct. All provisions laws and ordinances go ing this type
<br /> of work will be completed whether spec�ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with fhe State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> �z z �� E � � (� - 0 3�
<br /> Owner/ u rized Agent Signature Date (Revised 9/23/2016)
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